Ulnar Collateral
Ligament Rehabilitation
By: Michael Cox
Bony Anatomy
 Humerous:
Medial epicondyle- trochlea which serves as the axis of rotation for ulna on
the humeorus
Lateral epicondyle- capitellum which serves as the axis of rotation for the
radius
Radial fossa- accepts radial head during flx
Coranoid fossa- accepts coranoid process during flx
Olecronon fossa- accepts olecronon during ext
 Ulna:
Olecronon process
Coranoid process
 Radius:
Radial head
Radial tuberosity
Bony Anatomy
 Humeroulnar joint
Hinge joint
Strong and stable
Allows for flexion and extension
 Humeroradial joint
Modified ball and socket joint
 Proximal radioulnar joint
Allows for pronation and supination
Ligamentous support



Ulnar Collateral Ligament:
 Resists valgus loads
 3 bundles
 Anterior- taut throughout full ROM,
primary restraint against valgus stress
 Transverse- provides little medial support
 Posterior- taut in flexion beyond 60 degrees
Lateral Collateral Ligament:
 Resists varus forces
 Composed of radial collateral ligament,
 lateral ulnar collateral ligament,
 annular and accessory ligament
Annular Ligament:
Encases radial head
Doesn’t let ulna and radius move into
flexion and extension independently
Musculature
 Flexors:
 Biceps brachii, brachioradialis, brachialis
 Extensors:
 Triceps brachii, anconeus
 Forearm Pronators:
 Pronator teres, pronator quadratus
 Forearm Supinators:
 Supinator, assisted by biceps and brachioradialis
Mechanism of Injury
 Most ulnar collateral ligament injuries
occur in overhead throwing athletes
 This due to the extreme valgus stress
placed on the elbow throughout the throwing motion
 Acutely the UCL can also be injured
with a lateral blow to the elbow
Clinical Evaluation
 The patient will complain of pain on the medial aspect of the elbow that
increases with motion
 Tingling or numbness may be present due to the tensile force placed on the
ulnar nerve
 Point tender from the along the medial epicondyle
 Some swelling may be noticeable
 Positive valgus stress test
Acute treatment
 Refer patient for a MRI
 Restrict any throwing movements
 Can sling if more comfortable
 Modalities can be used to help reduce pain and inflammation such
as ice and electrical stimulation for gate theory pain control
Surgical Patients
 If surgery Is needed- “Tommy John”- usually uses palmaris
longus tendon as a graft to replace UCL
 Immobilization wit the arm at 90 degrees of flexion for 10-14
days
 At this time wrist and finger ROM exercises can be started
 Gripping exercises with puddy
 Shoulder ROM
Beginning Rehabilitation
Weeks 0-3
Goals:
Decrease pain and inflammation
Improve ROM
Retard atrophy
Early Rehab- Passive
ROM
 Passive extension with dumbbell hanging off table (towel under
joint)
2 lbs.for 5-7 minutes (long duration, low intensity stretch)
 Pulley flexion and extension
3 sets- 10 repetitions
 Clinician passive ROM
QuickTime™ and a
TIFF (LZW) decompressor
are needed to see this picture.
Early Rehab- Active ROM
Wand exercises: 3 sets- 10 repetitions
flexion
extension
pronation
supination
Wrist ROM
Active ROM
flexion, extension, pronation, supination
Early Rehab- Decreasing
Pain
 Joint Mobilizations- grade I and II oscillationsposterior glide
 Ice
 Electrical Stim
- gate theory
Early RehabStrengthening
 Isometrics
 flexion, extension, pronation, supination
• 3 sets of 10 repetitions holding contractions for about 5-10
seconds
•
Refrain from internal and external rotation due to the valgus stress
it places on the UCL
Intermediate
Rehabilitation
Weeks 4-8
Goals:
Improving strength and endurance
Reestablishing neuromuscular control
Maintain full ROM
Criteria: Near total ROM with minimal pain
Intermediate Rehabilitation
Isotonic exercises
Flexion
extension
pronation
supination
3 sets- 10 repetitions
Starting at 2lb dumbbell and progressing as strength increases
Wrist isotonic exercises
Rhythmic Stabilization
clinician assisted
swiss ball
4 sets- 20s
Diagonal PNF patterns
Body Blade
straight arm and at 90
Intermediate
Rehabilitation
Moderate Rehabilitation
Weeks 9-13
Goals:
 Advanced strengthening phase
 Increase total arm strength, power, endurance,
and neuromuscular control
 Prepare patient for functional return to play
activities
Criteria:
 Full non painful ROM
 Strength close to 70% of uninvolved limb
Moderate Rehabilitation
 Eccentric training
 Theraband- biceps and triceps
Moderate Rehabilitation
 Throwers 10- total arm strength
 Dumbbell abduction
 Prone dumbbell abduction
 Prone extension
 Internal rotation
 External rotation
 Theraband shoulder flexion and extension
 Progressive pushups
 Medicine ball punches- serratus anterior
 Diagonal D2 PNF
 Wrist flexion, extension, pronation, supination
Moderate Rehabilitation
Plyometrics
Med ball throws one hand
Soccer throw
Chest pass
Side to side
Plyometric press up
Moderate Rehabilitation
Progressive medicine ball plyometrics
Increased soccer throws
8-10 reps
Side hits
2 sets- 30 seconds
External rotation throws
3 sets- 10 reps
Final Rehabilitation
Weeks 14-26
Goal:
 Progressive functional drills
 Continue to increase strength, endurance, power
 Return to play
Criteria:
 Full ROM with no pain
 Full strength
Final Rehabilitation
 Throwing program
 Increase in distance and amount of throws
 Enough rest time in-between session: 2-3 days
Batting practice
 Tees
 Soft toss
 Slow pitching
 Against a pitcher
Return To Play
Full ROM
Full strength
No direct pain with throwing or hitting
Normal cardiovascular endurance
Physiologically ready
Article
Emphasizes maintaining full elbow
extension early
Important to strengthen elbow and wrist
flexors, and pronators- importance in
follow through phase
Rotator cuff strength
Progressive and essential rehabilitation
program
Summary
 Elbow joint has strong bony support as well as ligamentous and
capsular support
 Mechanism of injury is usually repetitive valgus stress
 Progressive rehab with certain criteria that must be met
before moving on
 Avoid internal and external rotation early in rehab due to
valgus stress it places on elbow
 Maintain cardiovascular endurance and core strength
throughout rehab
 Flexibility
 Continue strengthening once back to full participation to
decrease risk of re-injury
Questions
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